Repercusiones de "ObamaCare" para la reforma sanitaria en Chile / "ObamaCare": effects for the health reform in Chile

Health care raises structural issues in a democratic society, such as the role assigned to the central government in the management of health risk and the redistributive consequences generated by the implementation of social insurance. These are often cause of strong political controversy. This paper examines the United States of America health reform, popularly known as "ObamaCare". Its three main elements, namely individual mandate, creation of new health insurance exchanges, and the expansion of Medicaid, generated a redistribution of health risks in the insurance market of that country after almost a century of frustrated legislative efforts to guarantee minimum universal coverage. The article proposes that a change of this magnitude in the United States will produce effects in a forthcoming parliamentary discussion on the health reform in Chile, which still maintains a highly deregulated private health system.

Bacaba beverage produced by Umutina Brazilian Amerindians: Microbiological and chemical characterization

Bacaba chicha is a beverage prepared by the indigenous Umutina people from the bacaba fruit (Oenocarpus bacaba), a purple berry that is rich in fat and carbohydrates, as well as a source of phenolic compounds. In this study, samples of bacaba chicha beverage were collected, and the microbial community was assessed using culture-dependent and -independent techniques. The nutritional composition and metabolite profiles were analyzed, and species belonging to lactic acid bacteria (LAB) and yeasts were detected. The LAB group detected by culture-dependent analysis included Enterococcus hormaechei and Leuconostoc lactis. Polymerase chain reaction and denaturing gradient gel electrophoresis (PCR-DGGE) detected additional Propionibacterium avidum, Acetobacter spp., and uncultured bacteria. Pichia caribbica and Pichia guilliermondii were detected in a culture-dependent method, and Pichia caribbica was confirmed by PCR-DGGE analysis. The pH value of the beverage was 6.2. The nutritional composition was as follows: 16.47 ± 0.73 g 100 mL-1 dry matter, 2.2 ± 0.0 g 100 mL-1 fat, 3.36 ± 0.44 g 100 mL-1 protein, and 10.87 ± 0.26 g 100 mL-1 carbohydrate. The metabolites detected were 2.69 g L-1 succinic acid, 0.9 g L-1 acetic acid, 0.49 g L-1 citric acid, 0.52 g L-1 ethanol, and 0.4 g L-1 glycerol. This is the first study to identify microbial diversity in bacaba chicha spontaneous fermentation. This study is also the starting step in the immaterial record of this Brazilian indigenous beverage prepared from bacaba fruit.

Características demográficas de pacientes con enfermedad de pie-mano-boca. Serie de casos atípicos / Demographic characteristics of patients with hand-foot-and-mouth disease. Atypical cases series

La enfermedad de pie-mano-boca es un exantema frecuente en la niñez. Se han descrito varios tipos de lesiones de distribución generalizada en casos atípicos, aunque los datos sobre la predilección respecto de la localización de estas lesiones son insuficientes. Nuestro objetivo fue describir las características demográficas de los pacientes con esta enfermedad y caracterizar las localizaciones de las lesiones en pacientes con erupciones atípicas, tratadas en un centro ambulatorio de dermatología de un hospital pediátrico, entre noviembre de 2011 y agosto de 2013. Se incluyen a 67 pacientes en el estudio. La edad media de los pacientes fue de 34 meses con predominio de varones (60%). Todos los pacientes tuvieron erupciones en la boca, las manos y los pies. Los niños <24 meses se vieron afectados en la zona cubierta por el pañal y las extremidades, con un compromiso significativamente mayor en los que tenían entre 24 y 48 meses y en los >48 meses (p <0,0001 y p= 0,011, respectivamente). Ninguno de los pacientes tuvo complicaciones sistémicas graves.

Hand-foot-and-mouth disease (HFMD) is a common childhood exanthem. Various types of lesions and widespread distribution in atypical cases have been described, but data on the predilection of lesion localizations in atypical cases are insufficient. We aimed to describe the demographic features of patients with HFMD, and to characterize lesion localizations in patients with atypical eruptions treated at an outpatient dermatology clinic of a pediatric hospital, between November 2011 and August 2013.The study included 67 patients. Mean age of the patients was 34 months and there was a male predominance (60%). All the patients had eruptions on hands, feet, and mouth. Children aged <24 months had involvement of the diaper area and extremities, which was significantly higher than those aged 24-48 months and >48 months (P < 0.0001 and P= 0.011, respectively). None of the patients had serious systemic complications.

I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes / I Registro Brasileiro de Insuficiência Cardíaca – Aspectos Clínicos, Qualidade Assistencial e Desfechos Hospitalares

Background: Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results: A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence. .

Fundamento: A insuficiência cardíaca (IC) é uma das principais causas de hospitalização em adultos no Brasil, no entanto a maioria dos dados disponíveis é limitada a registros unicêntricos. O registro BREATHE é o primeiro a incluir uma ampla amostra de pacientes hospitalizados com IC descompensada de diferentes regiões do Brasil. Objetivo: Descrever as características clínicas, tratamento e prognóstico intra-hospitalar de pacientes admitidos com IC aguda. Métodos: Estudo observacional tipo registro, com seguimento longitudinal. Os critérios de elegibilidade incluíram pacientes acima de 18 anos com diagnóstico definitivo de IC, admitidos em hospitais públicos ou privados. Os desfechos avaliados incluíram causas de descompensação, uso de medicações, indicadores de qualidade assistencial, perfil hemodinâmico e eventos intra-hospitalares. Resultados: O total de 1.263 pacientes (64 ± 16 anos, 60% mulheres) foi incluído a partir de 51 centros de diferentes regiões do Brasil. As comorbidades mais comuns foram hipertensão arterial (70,8%), dislipidemia (36,7%) e diabetes (34%). Em torno de 40% dos pacientes apresentavam função sistólica do ventrículo esquerdo normal e a maioria foi admitida com perfil clínico-hemodinâmico quente-úmido. Vasodilatadores e inotrópicos endovenosos foram administrados a menos de 15% da amostra estudada. Indicadores de qualidade assistencial baseados nas orientações de alta hospitalar foram atingidos em menos de 65% dos pacientes. A mortalidade intra-hospitalar afetou 12,6% do total dos pacientes incluídos. Conclusão: O estudo BREATHE demonstrou a alta mortalidade intra-hospitalar dos pacientes admitidos com IC aguda no Brasil, somada à baixa taxa de prescrição de medicamentos baseados em evidências. .

Compensatory sweating after restricting or lowering the level of sympathectomy: a systematic review and meta-analysis

OBJECTIVE: To compare compensatory sweating after lowering or restricting the level of sympathectomy. METHOD: A systematic review and meta-analysis were conducted of all randomized controlled trials published in English that compared compensatory sweating after lowering or restricting the level of sympathectomy. The Cochrane collaboration tool was used to assess the risk of bias, and the Mantel-Haenszel odds ratio method was used for the meta-analysis. RESULTS: A total of 11 randomized controlled trials were included, including a total of 1079 patients. Five of the randomized controlled trials studied restricting the level of sympathectomy, and the remaining six studied lowering the level of sympathectomy. CONCLUSIONS: The compiled randomized controlled trial results published so far in the literature do not support the claims that lowering or restricting the level of sympathetic ablation results in less compensatory sweating. .

Support for disease management, depression, self-care, and clinical indicators among Hispanics with type 2 diabetes in San Diego County, United States of America / Indicadores clínicos y apoyo para el manejo de la enfermedad, la depresión, el autocuidado en hispanos que padecen diabetes tipo 2 en el Condado de San Diego, Estados Unidos

This study used a social-ecological framework to examine predictors of depression, diabetes self-management, and clinical indicators of health risk among Hispanics with type 2 diabetes residing in the United States (U.S.)-Mexico border region in San Diego County, California, United States of America. Important links were observed between greater social-environmental support for disease management and less depression, better diabetes self-management, and lower body mass index and serum triglyceride concentrations. Less depressive symptomatology was also related to lower hemoglobin A1c levels. Findings suggest that programs aiming to improve diabetes self-management and health outcomes in Hispanics with type 2 diabetes should consider multilevel, social, and environmental influences on health, behavior, and emotional well-being.

En este estudio se utilizó un marco socioecológico para analizar los factores predictivos de la depresión, la autogestión de la diabetes y los indicadores clínicos de riesgo para la salud en hispanos que padecen diabetes tipo 2 residentes en la zona fronteriza entre México y los Estados Unidos del Condado de San Diego en California. Se observaron vínculos importantes entre un mayor apoyo socioambiental para el manejo de la enfermedad y una presencia menor de la depresión, una mejor autogestión de la diabetes, y menores índices de masa corporal y concentraciones de triglicéridos séricos. La presencia menor de síntomas depresivos también se relacionó con niveles inferiores de hemoglobina A1c. Estos resultados indican que los programas dirigidos a mejorar la autogestión de la diabetes y los resultados en materia de salud en los hispanos que padecen diabetes tipo 2 deben tener en cuenta las influencias sociales y ambientales sobre la salud, el comportamiento y el bienestar emocional.